TENNESSEE MOTOR VEHICLE COMMISSION 500 JAMES ROBERTSON PARKWAY, 5TH FLOOR NASHVILLE, TN 37243-1153 PHONE 615.741.2711 FAX 615.741.0651 tn.gov/commerce/section/motor-vehicle

CONSIGNMENT AGREEMENT TO BE COMPLETED BY THE CONSIGNEE

(Pursuant to Tennessee Code Annotated § 55-17-114(b)(1)(M), the commission may deny an application for a license or revoke or suspend the license of a motor vehicle dealer or salesperson who possesses any certificate of title that is not a closed title, unless the motor vehicle dealer maintains an executed consignment form developed by the commission on each motor vehicle that does not have a closed title.)

NAME OF DEALER (CONSIGNEE) DATE OF CONSIGNMENT

ADDRESS OF DEALER (NUMBER AND STREET, CITY, STATE, ZIP) TELEPHONE NUMER ( ) SIGNATURE OF DEALER DEALER LICENSE NUMBER

THE ABOVE NAMED CONSIGNEE HAS TAKEN THE BELOW-LISTED VEHICLE ON CONSIGNMENT, TO BE SOLD. THE BELOW-LISTED CONSIGNOR HAS GIVEN HIS/HER CONSENT TO THE SALE AND PLACEMENT OF THE VEHICLE. THE OWNER OF THE VEHICLE WILL BE REQUIRED TO PRODUCE THE TITLE WHEN VEHICLE IS SOLD OR OWNERSHIP IS TRANSFERRED.

NAME OF OWNER (CONSIGNOR) TELEPHONE NUMBER ( )

ADDRESS OF OWNER (NUMBER AND STREET, BOX, CITY, STATE, ZIP)

PHYSICAL ADDRESS OF OWNER (NUMBER AND STREET, CITY, STATE, ZIP)

RESERVE PRICE FEE ARRANGEMENT

SIGNATURE OF OWNER 1 DATE (MONTH, DAY, YEAR)

SIGNATURE OF OWNER 2 (IF APPLICABLE) DATE (MONTH, DAY, YEAR)

THE DATE OF THIS CONSIGNMENT BEGINS THE DATE OF THIS CONSIGNMENT ENDS DISPLAY LOCATION OF THE VEHICLE

THE FOLLOWING INFORMATION MUST BE PROVIDED

VEHICLE ON CONSIGNMENT YEAR, MAKE AND MODEL OF VEHICLE VEHICLE IDENTIFICATION NUMBER (VIN) MILEAGE

NAME OF LIEN HOLDER (IF APPLICABLE) TELEPHONE NUMBER ( ) ADDRESS OF LIEN HOLDER (NUMBER AND STREET, CITY, STATE, ZIP)

NAME OF OWNER(S) ON TITLE

ADDRESS OF OWNER(S) ON TITLE (NUMBER AND STREET, CITY, STATE, ZIP)

HOME TELEPHONE NUMBER WORK TELEPHONE NUMBER BEST TIME TO CALL ( ) ( ) COPIES OF THE FOLLOWING DOCUMENTS MUST BE ATTACHED TO THIS CONSIGNMENT AGREEMENT. □ TITLE (FRONT AND BACK) □ POWER OF ATTORNEY (IF NECESSARY) □ CONSIGNOR’S DRIVER’S LICENSE □ REGISTRATION

IN-1829 (Rev 5/18) RDA 10222

THIS SECTION MUST BE COMPLETED IN ITS ENTIRETY.

TITLE INFORMATION TITLE NUMBER STATE OF ISSUANCE

HAS THIS TITLE BEEN BRANDED IN ANY WAY? (SALVAGED, REBUILT, FLOOD, METH, ETC.) IF YES, PLEASE INDICATE THE YES NO BRAND IN THE BOX PROVIDED. TITLE BRAND

IS THIS A SPECIALLY CONSTRUCTED OR KIT VEHICLE? YES NO

DOES THIS VEHICLE HAVE A SPECIALLY ASSIGNED VEHICLE IDENTIFICATION NUMBER (VIN)? IF YES, PLEASE INDICATE THE YES NO NUMBER IN THE BOX PROVIDED. SPECIALLY ASSIGNED VIN NUMBER

I HEREBY CERTIFY THAT THE STATEMENTS IN, OR ATTACHED TO THIS AGREEMENT ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I ATTEST I AM FAMILIAR WITH THE PROVISIONS OF THE LAW AND MY RESPONSIBILITIES AS A DULY LICENSED MOTOR VEHICLE DEALER, AND FURTHER ATTEST I WILL COMPLY WITH ANY AND ALL REQUIREMENTS ASSOCIATED WITH MY LICENSE.

I UNDERSTAND BY OFFERING A VEHICLE FOR SALE ON CONSIGNMENT, IT IS MY DUTY AS A LICENSEE TO INFORM ANY PROSPECTIVE CUSTOMER THE VEHICLE IS BEING SOLD ON CONSIGNMENT, AND FURTHER UNDERSTAND I AM REQUIRED TO DISCLOSE ANY MATERIAL FACTS ABOUT THIS VEHICLE, PRIOR TO THE SALE, TO A PROSPECTIVE BUYER.

CONSIGNOR WILL PROVIDE A GOOD TITLE TO A CONSIGNEE. A BILL OF SALE MAY NOT BE USED AS PROOF OF OWNERSHIP.

CONSIGNEE WILL NOT SELL ANY VEHICLE ON BEHALF OF CONSIGNOR WITHOUT A GOOD TITLE IN ITS POSSESSION.

I UNDERSTAND THAT CONSIGNMENT OF A VEHICLE IS PROHIBITED BETWEEN ONE LICENSEE AND ANOTHER.

I AGREE THAT UPON SELLING A CONSIGNED VEHICLE, THE CONSIGNEE SHALL, WITHIN FOURTEEN (14) CALENDAR DAYS OF THE DATE OF SALE, GIVE WRITTEN NOTICE TO THE CONSIGNOR OF THE SALE. IN ADDITION, THE CONSIGNEE SHALL REMIT THE PAYMENT RECEIVED TO THE CONSIGNOR WITHIN THIRTY (30) CALENDAR DAYS OF THE DATE OF RECEIVING PAYMENT IN FULL FOR THE VEHICLE, UNLESS THE PURCHASE AGREEMENT IS RESCINDED BEFORE THE EXPIRATION OF THIRTY (30) DAYS.

SIGNATURE OF CONSIGNEE (DEALER) SIGNATURE OF CONSIGNOR (OWNER)

THE FOLLOWING SECTION MUST BE COMPLETED BY A NOTARY PUBLIC

STATE OF COUNTY OF

SUBSCRIBED AND SWORN TO BEFORE ME NOTARY PUBLIC MY COMMISSION EXPIRES (MONTH, DAY, YEAR)

THE CONSIGNEE MUST MAINTAIN A COPY OF THIS AGREEMENT AT THE PRINCIPAL PLACE OF BUSINESS AND PRODUCE IT UPON REQUEST TO ANY AGENT OF THE MOTOR VEHICLE COMMISSION. FAILURE TO DO SO MAY RESULT IN CIVIL PENALTIES BEING ASSESSED PURSUANT TO TENNESSEE COMPREHENSIVE RULES AND REGULATIONS § 0960-1-.11

IN-1829 (Rev 5/18) RDA 10222